Today, UPMC-funded startup Health Fidelity announced the launch of Risk Analytics, a new solution that helps healthcare organizations further improve their risk adjustment performance by optimizing ROI, identifying care gaps, and providing a network-wide view of risk adjustment performance. Now available as a subscription, the new capability enables insurers to better predict prospective claims to help stabilize risk adjustment.
As a complement to the company’s existing HCC Scout solution, Risk Analytics identifies prospective risk adjustment opportunities in the form of suspected conditions that are not billed to governing entities. By applying proprietary Natural Language Processing (NLP) and big data analytics to unstructured data in clinical charts, Risk Analytics uncovers opportunities that other solutions miss due to incompleteness or inaccuracy in claims data. Risk Analytics can be used independently of, or in concert with, Health Fidelity’s retrospective risk adjustment solution, HCC Scout, to optimize an organization’s overall risk adjustment efforts.
“Despite keen awareness of the problem, most healthcare organizations still struggle with revenue leakage,” said Steve Whitehurst, Chief Executive Officer of Health Fidelity. “Research shows that 40% to 60% of chronic risk conditions are not being captured by plans across the industry. By combining Risk Analytics with HCC Scout, users can benefit from the most complete range of tools to identify, assess, and quantify the risk of patient populations.”
Using innovative technologies, Health Fidelity’s Risk Analytics is able to deliver more actionable information. It allows organizations to make better decisions about where to invest resources for capturing additional risk; it also provides insights for designing risk capture strategies. In addition to these capabilities, Risk Analytics offers easy-to-use dashboards for tracking the progress of prospective risk capture over time. It offers visualizations of program efforts, along with a number of reporting options to summarize performance.
In any healthcare organization, the most useful sources of risk adjustment data are locked away in clinical documents such as progress notes, lab/rad/path reports, admission/discharge papers, and other text-based documentation. Health Fidelity’s NLP technology is able to process content and extract meaning from freeform text, making it possible to include these unstructured data sources in risk adjustment analysis. As a result, Health Fidelity is able to provide the most complete analysis of health plan members.